PROJECT SUMMARY/ABSTRACT There is a looming social and economic liability with a growing elderly population. Annually, a staggering 2.8 million elderly are treated in emergency departments for fall injuries. Falls are the leading cause of traumatic brain injury and the primary cause of accidental death in adults over 65 years. Impaired balance, particularly in the lateral direction, is one of the most important risk factors for falls. Unfortunately, common clinical tests of balance are not sensitive to impairments. This lack of sensitivity makes it difficult to monitor changes in balance control that may increase a person's fall risk (e.g. following a change in medication). Therefore, there is a critical need for more sensitive tests to assess balance. We have shown that delays in neuromuscular control result in instability. This work along with the fact that elderly have slower postural adjustments prompted our research group to develop a test to assess speed of balance control. We have shown that speed of balance control can be reliably assessed, is sensitive to subtle impairments in balance not found with common clinical tests, and has ecological validity as demonstrated by predicting performance in common daily activities known to be predictive of falls. The product of this SBIR is a low-cost, easy-to-use system to assess speed of balance control, referred to as io-Balance. The aim of this SBIR will be to create and test the accuracy of the io-Balance system in assessing speed of balance control. In Phase II, we will provide 10 io- Balance systems to 5 large senior care facilities. We will collect io-Balance data on 200 older adults and monitor them for falls. This data will be used to create an initial predictive model to identify fallers. Given that the average hospital cost for a fall injury is $29,000, there is considerable motivation to prevent falls. The io- Balance system to assess balance will be provided for free to individual users. A professional version of io- Balance will be offered to healthcare providers (e.g., family physicians and physical therapists) and healthcare entities (e.g., hospitals, rehabilitation centers, and retirement facilities) through a paid subscription. Future io- Balance development will include a diagnostic test to identify source of impairments, physical-based games to train balance, and a fall detection system for seniors wishing to age at home. The global marketplace for elder- care technology products, focusing on remote health-monitoring and safety-monitoring, was valued at $3.7 billion in 2014 and is expected to grow annually 18.8% over the next five years.